Rethinking Addiction in the Age of Ozempic  🔗 **Source:** [Rethinking Addiction in the Age of Ozempic](https://share.snipd.com/episode/0971e9a3-0efe-4389-8aed-978ea4757126) ## Highlights - **Mary's Trial Showed Ozempic Quelled Alcohol Cravings** - Mary enrolled in a blinded clinical trial of semaglutide and within weeks lost interest in beer, switched to wine, then stopped drinking altogether. - She lost 55 pounds in five months, came off medication for weight reasons, and maintained sobriety afterward. Transcript: Dhruv Khullar I met Mary last year. She's a middle-aged woman, and she has been struggling with alcohol addiction for decades. She told me that she started drinking when she was 18 years old, and soon after she could drink something like 18 beers in the sitting and barely even seem buzzed. And Mary tried all sorts of things to try to cut back on her drinking. She entered Alcoholics Anonymous. She used a medication called Antabuse. She tried alcohol rehab, but none of them were effective. And she struggled with alcohol, and it started to really take a toll on many aspects of her life. Manoush Zomorodi Then, about a year ago, she was at a bar with a friend who usually also liked to drink a lot. Dhruv Khullar But that evening, Mary noticed that her friend had barely touched her drink. And her friend told her that she started taking Ozempic. And now she could barely bring herself to drink more than two beers at a time. And Mary was really interested in this. She'd always thought of Ozempic as kind of a obesity medicine or a diabetes medicine. And she was wondering, you know, what did it have to do with drinking? And as it happened, the next day, she saw this advertisement on Facebook that there was a clinical trial nearby that was studying whether Ozempic or semaglutide could help people with Alcohol addiction. So Mary enrolls in the trial, and every week, the researchers blindfold her, and they inject her with the medication. It's either placebo or it's semaglutide or ozempic. And within weeks, she notices that she doesn't really like to drink beer anymore, And this is something that she's been doing for decades. She switches to white wine. And then after that, she just stops drinking altogether. And what she told me was that ozempic really got rid of not just the food noise in her head, which is what a lot of people describe, but what happened for her was it took out alcohol noise. And so she had been ruminating about alcohol for most of her life, where to drink, how much to drink, how not to drink. And all of a sudden, that seemed to vanish. And she told me that she could finally start to think about other things in her life because alcohol wasn't really an issue anymore. And she made a lot of changes. She started exercising. She really improved her diet. She'd been having marital problems for years and always kind of thought about whether to end that relationship and suddenly did when she started on Ozempic during this trial. You know, in Mary's case, she also experienced pretty significant reduction in her appetite. And so there were days where she was eating, you know, three, four, 500 calories a day. And she lost 55 pounds in just five months. Oh my gosh. And she ended up having to come off the medication because she lost so much weight so quickly. ([Time 0:01:55](https://share.snipd.com/snip/b627d0fe-8b42-4486-88d5-75158ada7ce5)) - **Moderation Molecules May Limit Dopamine Surges** - GLP-1s may act as Transcript: Dhruv Khullar They don't extinguish our desires, but they help us keep them in check. And no one knows exactly why. One possibility is that they modulate what's called the brain's mesolimbic pathway, sometimes referred to as the reward system. Alcohol, nicotine, cocaine, social media, they all increase dopamine release in that pathway. And GLP-1s, they might be limiting the spikes of dopamine. So mice that are on the medications and given cocaine, they have smaller surges of dopamine, but they otherwise seem to maintain amounts of the neurotransmitter. ([Time 0:07:07](https://share.snipd.com/snip/a73f69be-dfaf-4e65-a6a5-95d466617c3f)) - **GLP-1s Suggest A Shared Biology For Many Addictions** - GLP-1s challenge prior thinking because they appear to reduce cravings across multiple addictions, not just appetite, suggesting a shared pathway for diverse addictive behaviors. - This contrasts with past treatments that targeted single addictions with distinct medications. Transcript: Manoush Zomorodi That addiction was biological, right? I remember the shift in thinking like in the 90s, a flip that happened in terms of not blaming people who have addictions, but blaming sort of the way their brains work. What is different about this? And was that wrong? Dhruv Khullar Well, I think, you know, there is still a lot of stigma around addiction. And so people who are struggling with addiction, I think there's a growing recognition that a lot of this is biological, that it's happening even unconsciously, and that people really Struggle in ways that, you know, they shouldn't be blamed for what's happening here. But I think there's still a lot of stigma that's preventing people from coming forward when they have an addiction. We have, as you said, made a lot of strides towards recognizing how much of a biological process addiction is. And so we've known that for many decades. Now, what's interesting here is that GLP-1s, they seem to work for many types of addictions, or at least there's the promise that it's working across various types of addiction. So if you think about the medications we've traditionally had to treat opioid use disorder or alcohol use disorder or nicotine use disorder, those are all separate medications. And we think that there's a particular mechanism or pathway through which they're operating. Here, GLP-1s, they seem to be acting across these different types of addictions, which is quite novel and interesting. ([Time 0:09:20](https://share.snipd.com/snip/89482eb0-5a82-4f37-8363-e7c9a990ead8)) - **Monitor Mood Effects And Retention When Using GLP-1s** - Recognize limitations: many people stop GLP-1s within a year, and some report mood blunting or anhedonia, so monitor psychological effects closely. - Account for GI side effects and high monthly costs when considering long-term use. Transcript: Dhruv Khullar That's right. So I think the first is that it can be hard for a lot of people to stay on these medications. And that's going to be a problem whether you're taking this for diabetes or obesity or addiction. Of course, drugs only work if you take them, but at least in some studies, half or more of people come off these medications within a year of starting to take them. And so, of course, that is going to limit how effective they can be if people aren't able to stay on them. It's also possible that some people experience psychological side effects. There have been reports, not a lot of great research yet, but at least reports that people feel kind of a blunted mood or even anhedonia. They're not interested in doing the things that they used to do. Are a lot of efforts underway to make these drugs more accessible, more available to people, either through insurance or other programs that are going to mitigate the cost. But at least the sticker price can still be $1,000 or $1,300 a month. And so as you can imagine, not a lot of people are going to be able to afford that. And finally, I would say, you know, side effects in terms of GI side effects. In clinical trials, they seem to be pretty well tolerated. So maybe 5% or 10% of people have, you know, significant enough GI side effects to come off them. ([Time 0:18:21](https://share.snipd.com/snip/e95695a7-3d85-40ed-a634-f12d17068b94)) - **Longer GLP-1 History Adds Some Safety Confidence** - GLP-1 medications have existed in earlier forms for two decades, offering some longitudinal safety reassurance even if newer, stronger formulations are recent. - Earlier drugs like exenatide showed fewer dramatic weight effects and limited long-term alarming signals. Transcript: Dhruv Khullar So the first GLP-1 medication out in 2005, 2006, Exanatide. And that had to be taken twice a day, and it didn't have as powerful effects on weight loss. And so it wasn't kind of the phenomenon that these newer GLP-1s have become. But there have been medications or versions of GLP-1s for two decades. And we haven't seen those really concerning side effects that have sometimes cropped up with other medications over the course of five or 10 years. ([Time 0:20:10](https://share.snipd.com/snip/2c71c888-9355-4db6-84d2-62f187e10fc4)) - **Moderation Is About Harmony With An Overstimulating World** - Moderation is framed as achieving harmony with an environment that now supplies excess food, content, and substances, meaning some people need social supports or medications. - Dhruv argues we must pair compassion with biological understanding rather than shame. Transcript: Dhruv Khullar A lot of the challenges that we have, whether it's around our mental health or our physical health, is trying to bring ourselves into greater harmony with our environment. And for some people, that will require medications. For some people, they'll require social supports, therapy. But I think getting to this place where we recognize that moderation is important, but that the modern world is one that facilitates too much is a really important kind of frame shift Just to think about, you know, how we should be engaging with all the delights around us. Manoush Zomorodi I mean, with all of this, as you point out in your talk, it makes it makes us rethink sort of assumptions we've made about people's morals or their personality for centuries. That someone is weak willed or has no, you know, has no discipline that they can't stop themselves from whatever, drinking, smoking, etc. Do you think that we're being set up for a new chapter, a new way of thinking about addiction and the way we talk about or treat people who struggle? I think so. Dhruv Khullar I mean, I think because these medications are so widely used, I mean, some of the estimates are that one in every seven, one in every eight people in the United States have been on a GLP-1 Medication at some point. So these are millions, tens of millions of people who are using these medications and are seeing the effects of them in their lives. You know, so I think there's going to be a different relationship both towards obesity as well as addiction. And for me, some of this really came home during my reporting for this piece. You know, I underwent an MRI scan. ([Time 0:23:33](https://share.snipd.com/snip/02575d19-fddd-461d-9e4e-bae19a029b6b)) - **Eric Zimmer's Descent To Heroin And Hitting Rock Bottom** - Eric Zimmer describes descending from experimental use to full-time heroin addiction where his life narrowed until heroin was everything. - At rock bottom he weighed 100 pounds, had hepatitis C, had been arrested, and faced decades in prison before a recovery that stuck. Transcript: Manoush Zomorodi What were you like when you were addicted? Were you, I don't know, who were you then? Tell me a little more about what it was like for you. Eric Zimmer I was a shifting person like many of us are, although the sands of addiction are a shift more than the average. I mean, in the beginning, my alcohol and drug use connected me to the world, and it made the world seem interesting, and I became more creative, and I became more fun to be around, and I Liked people more and all of that. Now, as time went on, what happened with me and my addiction is it just kept shrinking my world until at the end, there was just one thing. It was heroin. That was it. My entire life oriented around that simple thing. And by the time it ended, I was not much of a person. I weighed 100 pounds. I was jaundiced and yellow from hepatitis C. I had just been arrested and I was sleeping in the back of a van. And the prosecutor said I might be going to prison for 50 years. I was broken. I mean, I was a completely a shell of a person. And I wandered into treatment again. It wasn't my first time. But at that point, this one stuck and it began my journey out of that sort of addiction. ([Time 0:29:18](https://share.snipd.com/snip/f77f56e3-52c2-4912-9c64-49b7a4bf360d)) - **Peer Support Is A Crucial Piece Of The Recovery Puzzle** - Peer-based support complements medical and psychological treatment because lived experience offers practical empathy and models for recovery. - Eric notes peer support is becoming central across patient groups and mental health services. Transcript: Eric Zimmer I think undoubtedly so. We see a lot more peer-based support in all areas, right? Peer-based mental health support has become a big thing where people who have the lived experience are trained in how to support others and they support each other. I think that we see it in a lot of patient groups around medical conditions more and more, where there is peer support built into everything else that's happening. So I do think there is a role for medical experts and specialists. There's a role for medicines. And there is a role for people who understand each other, supporting each other. ([Time 0:39:15](https://share.snipd.com/snip/604f2068-33f1-4a19-a49f-35f1c4ac0a3b)) - **Use Self-Compassion To Learn From Setbacks** - Practice self-compassion when changing behavior: treat slips as data to learn from rather than proof of failure. - Ask what changed after a setback and adjust, because shame undermines motivation and learning. Transcript: Eric Zimmer One of the foundational foundational things I'm teaching people as we're learning to change is self-compassion. I mean, A, self-compassion is a great thing to do. It's just great to be in a brain that's nice. But it's also really foundational because part of learning any skill, I just used the word, is you have to learn. And when we are really, really hard on ourselves, and we're really down on ourselves, we don't learn, right? We end up with like, I'm such a piece of whatever, and I'm awful, and I'm lazy, and I never do that. Instead of what we want to do is go, huh, I wonder what happened there. Why was I doing great for three weeks, but this week is completely falling apart? What happened? What might I do different? That's just something I, you know, it doesn't happen overnight, but it is a matter of trying again and again to kind of go, okay, I'm not broken. I can do this, right? I just need to learn how. Too much guilt and shame doesn't do any good. I mean, shame and guilt is one of the driving factors of addiction. ([Time 0:42:27](https://share.snipd.com/snip/c9205180-766a-40fa-be87-945631b809ea))